Extended use of preprocedural data to detect expiratory airflow limitation in patients with atrial fibrillation scheduled for ablation

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background In patients with atrial fibrillation (AF), expiratory airflow limitation adds to overall morbidity and may impair the response to heart rhythm control strategies. Purpose We aimed to determine the prevalence of expiratory airflow limitation in patients scheduled for AF ablation and evaluated whether routine preprocedural cardiac analyses can detect occult lung disease. Methods Consecutive AF patients scheduled for catheter ablation were systematically screened for expiratory airflow limitation with handheld (micro)spirometry devices. As part of routine preprocedural care, patients underwent cardiac computed tomographic angiography (cCTA), transthoracic echocardiography and respiratory polygraphy. Qualitative analyses of cCT was performed for emphysema, airway abnormalities and lymphadenopathy. Sleep apnea severity and nocturnal desaturation were derived from polygraphy. Multivariate logistic regression was performed to assess if routinely preprocedural studies were associated with expiratory airflow limitation. Results (Micro)spirometry was performed in 110 consecutive patients and expiratory airflow limitation was detected in 25% of patients (previously unknown in 24 of 28 patients; Figure 1). Patients with expiratory airflow limitation more often presented with pulmonary abnormalities on cCTA, such as mild-to-severe emphysema (odds ratio [OR] 4.2, 95% confidence interval [CI] 1.12-15.1, p < 0.05), lymphadenopathy (OR 3.6, 95% CI 1.1-11.3, p < 0.05) and bronchial wall thickening (OR 2.6, 95% CI 1.0-6.5, p < 0.05; Figure 2). The negative predictive value of the absence of pulmonary abnormalities on cCTA to identify patients with normal lung function was 85%. Polygraphy-derived sleep apnea status and nocturnal desaturation was less severe in patients with expiratory airflow limitation compared to patients with normal lung function (32% vs 48% moderate-to-severe sleep apnea, p = 0.23; oxygen desaturation index 3.0 [2.4-6.5] vs. 6.7 [3.4-11.4], p = 0.03). Echocardiography data did not differ between patients with compared to patients without expiratory airflow limitation. Conclusions Spirometry detected expiratory airflow limitation in 25% of patients scheduled for AF ablation. Routine preprocedural cCTA includes pulmonary features which may help in triage referral for formal pulmonary assessment.